Changes in breast cancer treatment during the COVID-19 pandemic: a Dutch population-based study

Eijkelboom, Anouk H; Munck, Linda de; Oordt, Catharina W. Menke-van der Houven van; Broeders, Mireille J. M.; Bongard, Desirée H. J. G. van den; Strobbe, Luc J. A.; Mureau, Marc A.M.; Lobbes, Marc; Westenend, Pieter J.; Koppert, Linetta B.; Jager, Agnes; Siemerink, E.; Wesseling, Jelle; Verkooijen, Helena M.; Peeters, Marie‐Jeanne T. F. D. Vrancken; Smidt, Marjolein L.; Tjan‐Heijnen, Vivianne C. G.; Siesling, Sabine; Hoeve, Jolanda C. van; Merkx, M.A.W.; Wit, Niek J. de; Dingemans, I.; Nagtegaal, Irıs D.

doi:10.1007/s10549-022-06732-y

Cited by 12 publications

(16 citation statements)

References 26 publications

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“…Indeed, one UK study demonstrated that alterations to breast cancer management were implemented in nearly 60% of patients, and many surgical interventions were substituted with ‘bridging’ endocrine therapy [12]. In the Netherlands neo-adjuvant endocrine therapies for breast cancer increased by 339% during lockdown [13]. As well as reduced availability of surgical resources, radiotherapies and hospital beds, concern that chemotherapy-induced immunosuppression would increase risk for COVID-19 complications may have influenced clinicians’ decisions to switch patients to alternative therapies [14].…”

Section: Discussionmentioning

confidence: 99%

Collateral effects of the COVID-19 pandemic on endocrine treatments for breast and prostate cancer in the UK: implications for bone health

Barclay,

Català,

Jödicke

et al. 2023

Preprint

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BackgroundThe COVID-19 pandemic affected cancer screening, diagnosis and treatment pathways. This study examined the impact of the pandemic on incidence and trends of endocrine treatments in patients with breast or prostate cancer; and endocrine treatment-related side-effects.MethodsPopulation-based cohort study using UK primary care Clinical Practice Research Datalink (CPRD) GOLD database. There were 13,701 newly diagnosed breast cancer patients and 12,221 prostate cancer patients with ≥1-year data availability since diagnosis between January 2017-June 2022. Incidence rates (IR) and incidence rate ratios (IRR) were calculated across multiple time periods before and after lockdown to examine the impact of changing social restrictions on endocrine treatments and treatment-related outcomes, including osteopenia, osteoporosis and bisphosphonate prescriptions.ResultsIn patients with breast cancer, aromatase inhibitor prescriptions increased during lockdown compared to pre-pandemic (IRR: 1.22 [95% Confidence Interval: 1.11-1.34]), followed by a decrease post-first lockdown (IRR: 0.79 [95%CI: 0.69-0.89]). In patients with prostate cancer, first-generation antiandrogen prescriptions increased compared to pre-pandemic (IRR: 1.23 [95% CI: 1.08-1.4]). For breast cancer patients on aromatase inhibitors, diagnoses of osteopenia, osteoporosis and bisphosphonate prescriptions were reduced across all lockdown periods compared to pre-pandemic (IRR range: 0.31-0.62).ConclusionDuring the first two years of the pandemic, newly diagnosed breast and prostate cancer patients were prescribed more endocrine treatments compared to pre-pandemic, due to restrictions on hospital procedures replacing surgeries with bridging therapies. But breast cancer patients had fewer diagnoses of osteopenia and osteoporosis, and bisphosphonate prescriptions. These patients should be followed up in the coming years for signs of bone thinning. Evidence of poorer management of treatment-related side-effects will allow us to determine whether there is a need to better allocate resources to patients at high risk for bone-related complications.

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Section: Discussionmentioning

confidence: 99%

Collateral effects of the COVID-19 pandemic on endocrine treatments for breast and prostate cancer in the UK: implications for bone health

Barclay,

Català,

Jödicke

et al. 2023

Preprint

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“…Furthermore, the evidence regarding the impact of COVID-19 on treatment decisions for other types of cancer remains inconclusive. While some studies report a significant reduction in the use of adjuvant therapy [ 19 ], others indicate an increase in neoadjuvant therapy options [ 20 ]. The levels of evidence in these studies are not yet sufficient and do not yet allow to draw robust conclusions.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on management of surgically treated laryngeal squamous cell carcinoma

Lein,

Liu,

Haas

et al. 2023

Biomol Biomed

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The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the treatment of cancer patients, particularly in terms of treatment choices. This study aimed to assess the effects of the COVID-19 pandemic on the management of surgically treated laryngeal squamous cell carcinoma (LSCC) patients, focusing specifically on changes in treatment modalities. We retrospectively analyzed the data from 102 patients who underwent surgical treatment for LSCC between January 1, 2019, and December 31, 2021, at our tertiary medical center. Patient demographics, histological characteristics, and treatment modalities were extracted from electronic medical records and compared between two time periods: pre-COVID-19 and during COVID-19, marked by the introduction of the hospital entry triage. Of the total patients, 53 (52%) were in the pre-COVID-19 group, and 49 (48%) were in the COVID-19 group. No significant differences in patient characteristics at the initial work-up were observed between the two groups. However, a significant shift in treatment modalities was noted. Fewer patients received postoperative adjuvant therapy in the COVID-19 group (70.5%) compared to the pre-COVID-19 group (95.5%). Importantly, this change did not significantly impact the one-year overall survival (OS) rates. The reduction in the use of postoperative adjuvant therapy during the COVID-19 pandemic may be attributed to efforts to minimize hospital visits due to the risk of COVID-19 infection. Further research is warranted to validate these findings and to investigate the potential effects of such changes in treatment modalities on the long-term survival.

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“…In the pre-COVID period, fewer patients received chemotherapy (25.2% vs. 27.0%, p = .04). 489 (13) 1123 (13) 298 (12) 2609 ( 13) 977 ( 13) 1486 ( 14) 549 ( 14)…”

Section: Initial Treatmentsmentioning

confidence: 99%

“…[8][9][10][11] In patients with breast cancer, changes in treatments mainly included changes in the sequence of treatments. 12,13 No delays in initial treatment were found for any of the above mentioned cancers.…”

Section: Introductionmentioning

confidence: 95%

“…Based on data from the Netherlands Cancer Registry, treatment changes were shown to be limited and temporary for patients with colorectal cancer, prostate cancer, bladder cancer and head and neck cancers 8–11 . In patients with breast cancer, changes in treatments mainly included changes in the sequence of treatments 12,13 . No delays in initial treatment were found for any of the above mentioned cancers.…”

Section: Introductionmentioning

confidence: 99%

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Continuity of care for patients with de novo metastatic cancer during the COVID‐19 pandemic: A population‐based observational study

Slotman,

Weijzen,

Fransen

et al. 2024

Intl Journal of Cancer

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During the COVID‐19 pandemic recommendations were made to adapt cancer care. This population‐based study aimed to investigate possible differences between the treatment of patients with metastatic cancer before and during the pandemic by comparing the initial treatments in five COVID‐19 periods (weeks 1–12 2020: pre‐COVID‐19, weeks 12–20 2020: 1st peak, weeks 21–41 2020: recovery, weeks 42–53 2020: 2nd peak, weeks 1–20 2021: prolonged 2nd peak) with reference data from 2017 to 2019. The proportion of patients receiving different treatment modalities (chemotherapy, hormonal therapy, immunotherapy or targeted therapy, radiotherapy primary tumor, resection primary tumor, resection metastases) within 6 weeks of diagnosis and the time between diagnosis and first treatment were compared by period. In total, 74,208 patients were included. Overall, patients were more likely to receive treatments in the COVID‐19 periods than in previous years. This mainly holds for hormone therapy, immunotherapy or targeted therapy and resection of metastases. Lower odds were observed for resection of the primary tumor during the recovery period (OR 0.87; 95% CI 0.77–0.99) and for radiotherapy on the primary tumor during the prolonged 2nd peak (OR 0.84; 95% CI 0.72–0.98). The time from diagnosis to the start of first treatment was shorter, mainly during the 1st peak (average 5 days, p < .001). These findings show that during the first 1.5 years of the COVID‐19 pandemic, there were only minor changes in the initial treatment of metastatic cancer. Remarkably, time from diagnosis to first treatment was shorter. Overall, the results suggest continuity of care for patients with metastatic cancer during the pandemic.

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Changes in breast cancer treatment during the COVID-19 pandemic: a Dutch population-based study

Cited by 12 publications

References 26 publications

Collateral effects of the COVID-19 pandemic on endocrine treatments for breast and prostate cancer in the UK: implications for bone health

Collateral effects of the COVID-19 pandemic on endocrine treatments for breast and prostate cancer in the UK: implications for bone health

Impact of the COVID-19 pandemic on management of surgically treated laryngeal squamous cell carcinoma

Continuity of care for patients with de novo metastatic cancer during the COVID‐19 pandemic: A population‐based observational study

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